JMIR Publications

ABSTRACT

Background:

Digital transformation offers new opportunities to improve the exchange of infor-mation between different health care providers. Since information is particularly vulnerable to loss when a patient is discharged from hospital, digital transfor-mation offers great opportunities to improve intersectoral discharge management. However, most strategies for improvement have focused on structures within the hospital.

Objective:

The aim of this study was to evaluate the implementation of a digitalized discharge management system, the project “Optimizing intersectoral discharge management” (SEKMA, “Sektorübergreifende Optimierung des Entlassmanagements”) and its im-pact on the readmission rate.

Methods:

A mixed-methods design was used to evaluate the implementation of a digitalized discharge management and its impact on the readmission rate. After the implemen-tation, the congruence between the planned (logical model) and the implemented intervention was evaluated by means of fidelity analysis. Finally, bivariate and mul-tivariate analyses were employed to evaluate the effectiveness of the implementa-tion on the readmission rate. For this purpose, a Difference-in-Difference approach was conducted based on hospital routine data. The department of vascular surgery served as the intervention group, in which the optimized discharge management was implemented in April 2022. The departments of internal medicine and cardiol-ogy formed the control group.

Results:

A total of 26 interviews were conducted and 21 determinants were explored that could be divided into the three categories: "optimization potential", "barriers” and “enablers". Based on these results, 19 strategies were developed to address the determinants including lack of networking among health care providers, digital in-formation transmission and user-unfriendliness. A logical model was formulated based on these strategies that were prioritized by eleven hospital physicians. Seven of the strategies (e.g., electronic discharge letter, providing mobile devices to the hospital’s social service, generating individual medication plans in the format of the national medication plan) have been implemented to some extent in SEKMA. A sur-vey on the fidelity of application of the implemented strategies showed that three of these strategies were not yet widely applied. A significant effect of SEKMA on readmissions has not been observed in the hospital routine data.

Conclusions:

This study has shown that there is great potential in optimizing intersectoral col-laboration for patient care. Although, a significant effect of SEKMA on readmissions has not yet been observed, creating a digital ecosystem that connects different healthcare providers seems to be a promising approach to ensure secure and fast networking of the sectors. The described intersectoral optimization of discharge management provides a structured template for the implementation of a similar digital care networking infrastructure in other care regions.